癫痫后精神病性障碍期间的杀人行为。
Homicide during postictal psychosis.
作者信息
Eisenschenk Stephan, Krop Harry, Devinsky Orrin
机构信息
Department of Neurology, University of Florida, 1149 Newell Drive, Rm L3-100, Gainesville, FL 32611, USA.
Community Behavioral Services, 1212 N.W. 12th Ave., Ste. B, Gainesville, FL 32601, USA.
出版信息
Epilepsy Behav Case Rep. 2014 May 4;2:118-20. doi: 10.1016/j.ebcr.2014.04.001. eCollection 2014.
Postictal psychosis is characterized by a fluctuating combination of thought disorder, auditory and visual hallucinations, delusions, paranoia, affective change, and aggression including violent behavior. We present a case of homicide following a cluster of seizures. The patient's history and postictal behavior were his consistent with postictal psychosis. Contributing factors resulting in homicide may have included increased seizure frequency associated with a change in his AED regimen seizure frequency. The AED change to levetiracetam may also have increased impulsiveness with diminished mood regulation following discontinuation of carbamazepine. There is evidence that he had a cluster of seizures immediately prior to the murder which may have resulted in the postictal disinhibition of frontal lobe inhibitory systems. This homicide and other violent behaviors associated with postictal psychosis may be avoided with earlier recognition and treatment.
癫痫后精神病的特征是思维障碍、幻听和幻视、妄想、偏执、情感变化以及包括暴力行为在内的攻击行为的波动组合。我们报告一例癫痫发作群后发生杀人行为的病例。患者的病史和癫痫发作后的行为与癫痫后精神病相符。导致杀人行为的促成因素可能包括与抗癫痫药物（AED）治疗方案改变相关的癫痫发作频率增加。从卡马西平换成左乙拉西坦的AED改变也可能增加了冲动性，且停用卡马西平后情绪调节能力减弱。有证据表明，他在谋杀前立即出现了癫痫发作群，这可能导致了额叶抑制系统的癫痫发作后去抑制。通过早期识别和治疗，可以避免这种杀人行为以及其他与癫痫后精神病相关的暴力行为。
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